PHYSICAL THERAPY & REHAB
The efficacy of treadmill training with and without projected visual context for improving walking ability and reducing fall incidence and fear of falling in older adults with fall-related hip fracture: a randomized controlled trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2017;5(17):7 BMC Geriatr. 2016 Dec 28;16(1):21570 patients who had suffered a fall-related hip fracture and were undergoing acute postoperative rehabilitation for 6 weeks were randomized to one of three regimens: adaptability treadmill training in addition to usual physical therapy sessions; conventional treadmill training in addition to usual physical therapy sessions; or usual physical therapy sessions alone. Patients were assessed for measures of walking ability, walking adaptability, fear of falling and the incidence of falls at the end of the 6-week programs, and at 4-week and 12-month follow-up. All three groups significantly improved in general walking ability, general health, and fear of falling over time. The only significant differences noted in a priori analyses were a greater increase in the Functional Ambulation Category in the conventional treadmill group compared to the other two groups after 4 weeks, and a smaller reduction in walking speed during the 10-meter walking test with obstacles in the adaptability treadmill group compared to the conventional treadmill group. All other outcomes did not significantly differ between the three groups.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
1/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Falls within the elderly population are common and can result in serious injuries, such as hip fracture. Accordingly, interventions for fall avoidance and prevention are an important area of research currently. Walking adaptability and stepping training using a specialized treadmill is an intervention that has been suggested to reduce the incidence of falls in elderly individuals, though efficacy has not been investigated in a number of trials previously.
Qual era a principal questão de investigação?
In elderly patients following a fall-related hip fracture, does adaptability treadmill training lead to significantly better walking ability, significantly reduced fear of falling, and significantly lower incidence of fall when compared to either conventional treadmill training or usual physical therapy?
Quais foram os resultados importantes?
- For measures of walking ability, no significant differences were observed between the three groups in the outcome of the Performance Oriented Mobility Assessment, the Elderly Mobility Scale, the Timed Up-and-Go test or the Nottingham Extended Activities of Daily Living (all p>0.05).
- Increase in FAC from baseline was significantly greater in the conventional treadmill group compared to the adaptability treadmill group and usual physical therapy group at post-intervention and after 4-week follow-up (p<0.05); the difference between groups in the increase to 12-month follow-up was not significant (p=0.417).
- For measures of walking adaptability, the only significant difference between groups was a significantly smaller decrease in walking speed with obstacle avoidance during the 10MWT at post-intervention in the adaptability treadmill group (-21.48+/-18.13%) compared to the conventional treadmill group (-35.91+/-18.56%) (p=0.017); difference compared to the usual physical therapy group (-31.77+/-15.52%) did not reach statistical significance (p=0.070).
- The difference between groups in the decrease in walking speed with obstacle avoidance during the 10MWT at 4-week follow-up was not significant (p=0.091).
- Falls Efficacy Scale International scores did not significantly differ between the three groups at post-intervention, 4-week follow-up, or 12-month follow-up (p>0.05).
- The incidence of falls included 11 falls among 4 patients of the adaptability treadmill group, 11 falls among 5 patients of the conventional treadmill group, and 20 falls among 9 patients of the usual physical therapy group; the differences between groups were not statistically significant (p>0.05).
De que é que me devo lembrar mais?
In post-hip fracture rehabilitation in the elderly, adaptability treadmill training over 6 weeks in addition to standard physical therapy session results in statistically similar results to conventional treadmill training and usual physical therapy when considering measures of walking ability, walking adaptability, fear of falling and incidence of falls. The only significant differences noted in a priori analyses were a greater increase in the Functional Ambulation Category in the conventional treadmill group after 4 weeks and a smaller reduction in walking speed during the 10-meter walking test with obstacles in the adaptability treadmill group compared to the conventional treadmill group.
Como é que isto afectará o tratamento dos meus doentes?
The results of this study suggest that adaptability treadmill training for elderly patients following hip fracture produces similar results to that of either conventional training or a usual physical therapy program for 6 weeks. However, with only 70 patients enrolled and randomized, the study fell well short of the original 126 sample size based on previous calculations. For this reason, the study is likely underpowered for any clear conclusion on the efficacy of adaptability treadmill for these patients. Therefore, additional studies are required before its potential role in post-hip fracture rehabilitation is determined.
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